Pharmacokinetics of lidocaine after bilateral ESP block

2020 ◽  
Vol 46 (1) ◽  
pp. 86-89 ◽  
Author(s):  
Alessandro De Cassai ◽  
Claudio Bonanno ◽  
Roberto Padrini ◽  
Federico Geraldini ◽  
Annalisa Boscolo ◽  
...  
Keyword(s):  
Pain Treatment ◽  
Case Series ◽  
Ideal Body Weight ◽  
Compartment Model ◽  
Erector Spinae ◽  
Lumbar Spine Surgery ◽  
Perioperative Analgesia ◽  
Elimination Half ◽  
Wide Range ◽  
Rate Of Absorption

IntroductionErector spinae plane (ESP) block is an emerging interfascial block with a wide range of indications for perioperative analgesia and chronic pain treatment. Recent studies have focused their attention on mechanisms of action of ESP block. However, the pharmacokinetics of drugs injected in ESP is, as of now, uninvestigated. The aim of this brief report is to investigate the pharmacokinetics of lidocaine in a series of 10 patients.MethodsWe are reporting a case series of 10 patients undergoing bilateral ESP block for multilevel lumbar spine surgery.ESP was performed with 3.5 mg/kg of lidocaine based on ideal body weight. Lidocaine concentration was dosed at 5, 15, 30 min and at 1, 2 and 3 hours.ResultsTmax was 5 min for all the patients. Cmax ranged from 1.2 to 3.8 mg/L (mean: 2.59 mg/L). AUC0-3 was high (76%, on average) suggesting an almost complete bioavailability. Age had a negative correlation with T½ of lidocaine.ConclusionsLidocaine pharmacokinetic after ESP block is well-described by a two-compartment model with a rapid and extensive rate of absorption. Nevertheless, its peak concentrations never exceeded the accepted toxicity limit. Elimination half-life was slightly prolonged, probably due to the advanced age of some patients.

and σ +σ { , respectively, the KL } D ( for PBE ) is 111d(f ) = (µ −µ ) + − 2. (7.17) 2 σ For IBE, the { KLD is 1 }( ) d(f ) = (µ +σ + 2 − 2, 2 σ σWR (7.18) where σ = Var(s ) = σ − 2ρσ σBR . Advantages of using the KLD are that it: (1) possesses a natural hi-erarchical property such that IBE implies PBE and PBE implies ABE, (2) satisfies the properties of a true distance metric, (3) is invariant to monotonic transformations of the data, (4) generalizes easily to the mul-tivariate case where equivalence on more than one parameter (e.g., AUC, Cmax and Tmax) is required and (5) is applicable over a wide range of distributions of the response variable (e.g., those in the exponential fam-ily). Patterson et al. (2001) and Dragalin et al. (2002), described the results of a simulation study and a retrospective analysis of 22 replicate design datasets, to compare testing for IBE using the KLD with testing based on the FDA-recommended metric defined earlier in Section 7.4. One notable finding of these studies was that the KLD metric identified more datasets as being of concern than the FDA-recommended metric. This appeared to be due to ability of the FDA-recommended metric to reward novel formulations for which the within-subject variance is decreased relative to the reference. 7.8 Modelling pharmacokinetic data Although AUC and Cmax are adequate for testing for bioequivalence, there is sometimes a need to model the drug concentrations over time. Fitting such models aids the understanding of how the drug is absorbed and eliminated from the body, as well as allowing model-based estimates of AUC and Cmax to be obtained. A popular type of model that is fitted in these circumstances is the compartmental model, which considers the body as made up of a number of compartments through which the drug circulates. For example, the circulating blood might be considered as the single compartment in a one-compartment model. If a drug is taken orally as a tablet, say, the drug is absorbed into this compartment as the tablet dissolves in the stomach and is eliminated from this compartment by (among other things) the actions of the liver and kidneys. While the tablet is still being dissolved in the stomach, the rate of absorption of the drug into the circulating blood is greater than the rate that is eliminated

2003 ◽  
pp. 372-372
Keyword(s):  
Simulation Study ◽  
Compartment Model ◽  
The Body ◽  
Pharmacokinetic Data ◽  
Response Variable ◽  
True Distance ◽  
Drug Concentrations ◽  
Wide Range ◽  
Rate Of Absorption ◽  
Over Time

Postoperative Thoracic Pain Treatment: Serratus Anterior or Erector Spinae Plane Block?

2020 ◽  
Author(s):  
Ayşe Ülgey ◽  
Sibel Seçkin Pehlivan ◽  
Ömer Faruk Demir
Keyword(s):  
Pain Management ◽  
Thoracic Surgery ◽  
Pain Treatment ◽  
Postoperative Pain Management ◽  
Erector Spinae ◽  
Morphine Consumption ◽  
Serratus Anterior ◽  
Thoracic Pain ◽  
Erector Spinae Plane Block ◽  
Pca Method

Abstract Background Thoracic surgery is one of the most painful surgeries. Effective analgesia is important in postoperative pain management. In this study, we aimed to compare the two new fascial block techniques. Methods A total of 107 patients who underwent thoracic surgery between October 2018 and November 2019 were retrospectively evaluated. The study included 59 patients in the serratus anterior plane block (SAPB) group and 48 patients in the erector spinae plane block (ESPB) group. Both groups were administered 30 mL of 0.25% bupivacaine and their morphine consumption was evaluated by a patient-controlled analgesia (PCA) method during the 2nd, 6th, 12th, 24th, and 48th postoperative hours. Pain was measured with the visual analog scale (VAS). Intraoperative mean arterial pressure (MAP) and heart rate (HR) were recorded. Results During the first 24 hours, VAS values were significantly lower in the ESPB group (p < 0.05). Moreover, morphine consumption was significantly lower in the ESPB group in the 24th and 48th hours (p < 0.05). Intraoperative remifentanil consumption was also significantly lower in the ESPB group (p < 0.05). Intraoperative MAP in the ESPB group was found to be significantly lower after the 4th hour. HR was similar in both groups. Conclusion ESPB was more effective compared with SAPB in postoperative thoracic pain management.

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